Paramedics were not able to access educators when they wanted to, and a lack of CTOs meant there were delays in getting returning paramedics back to work.

Two years on, the ratio of educators to paramedics in western Sydney has ballooned to 1:211, almost three times recommended ratio, according to staffing figures obtained by the Health Services Union (HSU).

In south west Sydney there are 188 paramedics to a single CTO, two-and-a-half times the recommendation.

In South East and Central Sydney, the ratio is 1:177, and in North Sydney there are 146 paramedics for every CTO.

Paramedic CTO and HSU delegate Allison Moffitt said the roles of responsibilities foisted upon educators have increased markedly, but their ranks have not.

"There is an untenable workload pushed onto educators because of a lack of staff," Mrs Moffitt said.

"We're not even close to where we need to be, There is just not enough of us to effectively support our paramedics."

Mrs Moffitt said the pressure has taken its toll on educators as well as frontline staff.

"They work in really difficult conditions under really stressful circumstances and are short staffed themselves. They turn to us for support and when we can't give it to them, that is a really hard thing for us to deal with."

"We feel like we're letting them down."

Educator to paramedic ratios

West Sydney 1:211

South west Sydney 1:188

South east and central Sydney 1:177

North Sydney 1:146

Being "severely understaffed" on the front lines and in eductors ranks will also have flow-on effects for patients, Mrs Moffitt said.

When NSWA decide to roll out a new training module, CTOs are tasked with creating the content and teach the course in addition to their already overwhelming workload that sees them travel between ambulance stations to oversee paramedics' follow up training.

CTOs are currently working on a suite of new maternal care training covering medical emergencies involving pregnant women and their unborn babies.

The skills paramedics need to respond to birthing complications including breech birth and prenatal haemorrhage are not routine, and paramedics will need considerable training and support to master the techniques.

The relative rarity of encountering a birthing complication only reinforced the importance of thorough and ongoing training to cement the knowledge, Mrs Moffitt said.

"It's a big area of need for us [in terms of training] because it's not something paramedics do everyday.

Health Services Union NSW secretary Gerard Hayes said the community expected paramedics to be prepared for critical health emergencies across the gamut of medical scenarios, and capable of dealing with the most extreme presentations in volatile situations.

The HSU is urging the state government to fund an additional 31 educators.

"Over the next 20 years, this state will grow by several million people. NSW desperately needs investment in its paramedic workforce to keep pace with that growth.

"Unfortunately, the current government's investment in paramedic skills and training is a fail."

In a statement, a spokesperson for NSWA said the service had 70 dedicated staff to support training and eduction of frontline paramedics and two new CTOs recently started in Sydney, as well as an additional aeromedical educator starting in the new year.